Breath of Fresh Air: Feature Articles

Chapter 33: How many times a day can I safely use my bronchodilator inhaler?

Bronchodilators are medications that relieve asthma symptoms by causing the muscles that surround the airways to relax, thereby opening the breathing passageways. Commonly used bronchodilator inhalers are albuterol (Ventolin® and Proventil®), metaproterenol (Alupent® and Metaprel®), and pirbuterol (Maxair® and Maxair Autohaler®).

The medications in all of these bronchodilator inhalers are said to work for about 4-6 hours after you use them. Therefore, the simple answer to the question above is that it is safe to use these inhalers 4-6 times per day.

(Note that the bronchodilator inhaler salmeterol (Serevent®) is the exception. Its effect lasts for approximately 12 hours and, therefore, should not be used more than twice per day. The remarks that follow do NOT pertain to salmeterol. Salmeterol should never be used for quick relief of symptoms of asthma.)

The situation changes when asthma flares up and you are having an attack. If you have ever been to the Emergency Department of a hospital for your asthma, you know that bronchodilator medications can be given safely as often as every 20 minutes for quick relief of an asthma attack. The same is true at home. If you are having worsened asthma symptoms and need quick relief, you can safely use your inhaler as often as every 30-60 minutes for 2-3 hours without significant risk of harmful side effects. In particular, unless you have a known serious heart condition, there is no danger to your heart when using bronchodilator inhalers with this frequency for a short period of time.

There is a risk from using your bronchodilator inhalers too much, but the danger is not to your heart. The risk is that over-reliance on a medication that only relaxes the muscles surrounding the breathing tubes will lead to a delay in the administration of other, needed medications that will reduce the swelling and congestion of the breathing tubes. That is to say, while you get brief relief of asthmatic symptoms from your bronchodilator inhaler, your asthma may be worsening as the breathing tubes become more swollen and filled with mucus. It is possible to overuse bronchodilators to the point of delaying other, crucial treatments, usually in the form of steroid medications taken in tablet form.

Think of it this way: how often you need your bronchodilator medication for relief of asthmatic symptoms can be a useful indicator of how well your asthma is under control. If you need your bronchodilator inhaler every day, several times a day, there are probably better treatments that you should be receiving to keep your asthma quiet. If you need your bronchodilator inhaler as often as every 1-2 hours for relief of asthma symptoms, you are having an attack and need to do something immediately to prevent difficulty in breathing that is potentially dangerous. What actions to take in such an urgent situation should be specified as part of your asthma “Action Plan." More about asthma "Action Plans" in Chapter 7, “Developing Your Asthma “Action Plan.”